Tag: nevin manimala

Ann Am Thorac Soc. 2025 Jan 29. doi: 10.1513/AnnalsATS.202409-906OC. Online ahead of print.

ABSTRACT

RATIONALE: Tobacco smoking is a well-established risk factor for idiopathic pulmonary fibrosis (IPF), yet the influence of early-life tobacco exposure on future IPF risk remains poorly understood.

OBJECTIVES: To test the hypothesis that early-life tobacco exposure may elevate the risk of developing IPF, with this effect potentially modified by genetic susceptibility to IPF and mediated through accelerated biological aging.

METHODS: Using data from over 430,000 participants in the UK Biobank, we performed a prospective cohort study to examine the associations of maternal smoking around birth and age of smoking initiation with IPF risk. We evaluated the combined effects and interactions between early-life tobacco exposure and genetic susceptibility to IPF, quantified using polygenic risk scores. We assessed biological aging, as measured by telomere length and phenotypic age, as potential mediators in the associations between early-life tobacco exposure and IPF risk. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS: Maternal smoking around birth was associated with a higher risk of IPF (HR: 1.26; 95% CI: 1.11-1.43). Compared to never-smokers, individuals who initiated smoking in childhood (HR: 3.65; 95% CI: 3.02-4.41), adolescence (HR: 2.64; 95% CI: 2.28-3.05), and adulthood (HR: 2.09; 95% CI: 1.79-2.44) exhibited increased IPF risk (P for trend < 0.001). An additive interaction was observed between age of smoking initiation and genetic risk for IPF. Individuals with high genetic risk, maternal smoking exposure, and childhood smoking initiation had a 16-fold greater risk of IPF (HR: 16.47; 95% CI: 9.57-28.32), compared to those with low genetic risk and no tobacco exposure. Telomere length and phenotypic age each mediated approximately 10% of the effect of maternal smoking on IPF, with weaker mediation effects observed for later ages of smoking initiation.

CONCLUSION: Early-life tobacco exposure may elevate the risk of IPF, with effect modified by genetic susceptibility and partially mediated through accelerated biological aging.

PMID:39879538 | DOI:10.1513/AnnalsATS.202409-906OC

Cancer Biother Radiopharm. 2025 Jan 29. doi: 10.1089/cbr.2024.0194. Online ahead of print.

ABSTRACT

Purpose: To evaluate the use of yttrium-90 (Y90) dosimetry in predicting treatment outcomes when used following transarterial radioembolization with SIR-Spheres® (Resin Y90) in patients with hepatic tumors. Materials and Methods: This single institution retrospective analysis included 100 patients with hepatocellular carcinoma, colorectal carcinoma or other liver metastases who underwent transarterial radioembolization with resin Y90 and had imaging follow-up within one year of treatment. Mean tumor dose and mean dose to nontumor was calculated using voxel-based dosimetry software. Descriptive statistics were reported and methods of analyses included simple and multivariable linear regression, contingency table analyses, Kaplan-Meier estimation, and Cox proportional hazards models. Results: Of 100 patients included, 65 demonstrated tumor shrinkage following transarterial radioembolization. Of these, 20 (30.8%) had hepatocellular carcinoma, 22 (33.8%) had colorectal carcinoma, and 23 (35.4%) had other types of metastases. There was an association between tumor shrinkage and mean tumor dose (p = 0.0285) and mean dose to nontumor (p = 0.0028) in hepatocellular carcinoma patients, but not colorectal carcinoma, or the other subgroup. For all 100 patients, time to death and mean tumor dose was associated only in the other subgroup (p = 0.0260), but not in the hepatocellular or colorectal carcinoma groups. Time to death and mean dose to nontumor was associated in hepatocellular carcinoma patients (p = 0.0421), but not the colorectal carcinoma or other subgroup. Conclusions: Voxel-based dosimetry assessment is a tool that may be utilized to assist in predicting treatment outcomes in responders to transarterial radioembolization.

PMID:39879533 | DOI:10.1089/cbr.2024.0194

J Am Coll Health. 2025 Jan 29:1-10. doi: 10.1080/07448481.2024.2446441. Online ahead of print.

ABSTRACT

Objective: This research effort developed, implemented, and evaluated an inexpensive poster campaign designed to influence on-campus mental health culture and stigma. Participants: 124 students at a Californian graduate-only university participated in the evaluation. Methods: A single-group, pretest-posttest, quasi-experimental design tested the effect of exposing graduate students to posters carrying attribution-based messages. The campaign lasted for seven weeks in 2023. Results: Although not all outcomes were influenced, statistically significant increases in perceptions of mental health culture and willingness to disclose mental health struggles to peers and faculty were detected with medium effect sizes. There were also statistically significant increases in visits to an intervention website advertised exclusively on campaign materials. No backfiring effects were detected, an issue that campaigns must be vigilant about. Conclusion: Given the low cost of implementation, this mental health campaign represents an inexpensive, low-effort approach that can favorably influence graduate student perceptions of campus mental health culture and willingness to disclose.

PMID:39879525 | DOI:10.1080/07448481.2024.2446441

Arq Bras Cardiol. 2025 Jan 27;122(1):e20240213. doi: 10.36660/abc.20240213. eCollection 2025.

ABSTRACT

BACKGROUND: There is still a significant population of patients with embolic stroke of Undetermined Source (ESUS) whose specific attributable cause of the stroke remains unknown.

OBJECTIVES: Our research aimed to assess clinical, electrocardiogram, laboratory, and echocardiographic parameters that may predict the propensity of paroxysmal atrial fibrillation (PAF).

METHODS: We enrolled seventy-five ESUS patients who were in sinus rhythm at the time of stroke diagnosis to undergo in-hospital 7-day Holter monitoring, testing for Pro-BNP, and a standard echocardiographic examination. For statistical analysis, a P-value < 0.05 was considered significant.

RESULTS: The average age of the 75 ESUS patients was 58 years old. 60% of the patients were male, and the most prevalent concomitant condition was hypertension (53.3%). Forty patients had atrial cardiopathy, and 15 patients had PAF episodes. Hypertension and the E/e- > 12 were independent predictors of atrial cardiopathy, with p-values of 0.001 and 0.02, respectively. In patients with atrial cardiopathy, multivariable regression analysis was performed; PTFV > 5000 Mv.ms, LA volume index > 34 ml/m2, and ejection fraction < 45% were significant independent predictors of AF with significant p values of 0.001, < 0.001, and 0.001 respectively.

CONCLUSIONS: In ESUS patients, atrial cardiopathy was prevalent. Hypertension and an E/e- ratio greater than 12 were independent predictors for it. Multivariable regression analysis identified PTFV1 > 5000 mV.ms, LA volume index > 34 ml/m2, and ejection fraction < 45% as independent predictors for new-onset atrial fibrillation.

PMID:39879513 | DOI:10.36660/abc.20240213

Arq Bras Cir Dig. 2025 Jan 27;37:e1868. doi: 10.1590/0102-6720202400074e1868. eCollection 2025.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has overloaded healthcare systems worldwide. Other diseases, such as neoplasms, including gastric cancer, remained prevalent and had their treatment compromised.

AIMS: The aim of this study was to evaluate the impact of the COVID-19 pandemic on the treatment of gastric cancer and adherence to the recommended preoperative COVID-19 screening protocol.

METHODS: A retrospective study evaluated patients diagnosed with gastric adenocarcinoma who underwent surgical treatment between 2015 and 2023.

RESULTS: A total of 769 patients with gastric cancer were evaluated and organized into two groups: (i) pre-COVID group and (ii) COVID group. The pre-COVID group consisted of 527 patients operated on between 2015 and 2019, and the COVID group consisted of 242 patients from 2020 to 2023. The average number of surgical procedures per year in the pre-COVID group was 105 and 81 in the COVID group. There was a statistically significant difference between ASA classification (p=0.002) and clinical staging (p=0.015), which were worse in the COVID group. We observed an increase in diagnostic surgeries (p=0.026), with an increase in the minimally invasive route (p<0.001). In patients undergoing curative surgery, there was a greater indication for postoperative ICU (p=0.022) and neoadjuvant chemotherapy (p<0.001). There was no difference in 30- and 90-day mortality.

CONCLUSIONS: The surgical and oncological outcomes for patients operated on during the pandemic remained uncompromised, even though many presented with more advanced initial stages and poorer clinical performance. High adherence to protocols and a low rate of complications related to coronavirus indicate that surgeries were performed safely during this period.

PMID:39879512 | DOI:10.1590/0102-6720202400074e1868

Braz J Biol. 2025 Jan 27;84:e284867. doi: 10.1590/1519-6984.284867. eCollection 2025.

ABSTRACT

One of the biggest public health problems globally is that of iron deficiency anemia. The present research aimed to determine the effect of prebiotics along with iron fortification on iron biomarkers in female anemic rats as some evidence suggests that prebiotics convert increase the solubility of iron, thereby enhancing its absorption. A total of 126 Sprague Dawley rats were fed with sixteen different types of fortified feed containing prebiotics (Inulin + Galacto Oligosaccharides) and Iron Fortificants (Sodium Ferric Ethylenediaminetetraacetate + Ferrous Sulphate). The duration of the trials was 3 months aimed at determining the effect of iron fortification and prebiotics on different iron biomarkers including Hemoglobin (Hb), Hematocrit, Red Blood Cell (RBC) count, Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH) and Mean Corpuscular Hemoglobin Concentration (MCHC). The trials resulted in statistically significant improved iron biomarkers among female anemic rats (P-value < 0.05). It was concluded that iron fortification and prebiotics in combination were able to increase the levels of iron biomarkers in female anemic rats.

PMID:39879502 | DOI:10.1590/1519-6984.284867

Braz J Biol. 2025 Jan 27;84:e284742. doi: 10.1590/1519-6984.284742. eCollection 2025.

ABSTRACT

Leishmaniasis, caused by the Leishmania parasite, remains a persistent public health challenge in Pakistan. Despite control efforts, the disease prevalence continues to rise, particularly among pediatric populations. Understanding prevalence patterns and transmission dynamics is critical for effective control strategies. This study aims to analyze leishmaniasis prevalence data from January 2016 to July 2023 in Pakistan. Specific objectives include assessing temporal trends, demographic patterns, and geographical hotspots of transmission, while emphasizing the need for enhanced surveillance and research for targeted interventions. Retrospective analysis was conducted on leishmaniasis prevalence data collected from multiple healthcare facilities across Pakistan. Data included results from diagnostic tests on suspected cases, encompassing both pediatric and adult patients. Descriptive statistical analysis was employed to evaluate prevalence rates, demographic characteristics, and geographical distribution of positive cases. Analysis revealed an increasing trend in leishmaniasis prevalence over the study period. Initially, from 2016 to 2020, a positivity rate of 27% was observed exclusively among pediatric patients in Islamabad, with no adult cases. Subsequently, from 2017 to 2022, the positivity rate increased to 42%, affecting both pediatric and adult populations in Islamabad, Rawalpindi, and Swat. Notably, between July 2022 and July 2023, the positivity rate surged to 56%, primarily impacting adult males in the identified hotspots. The study provides evidence of rising leishmaniasis prevalence in Pakistan, particularly among pediatric patients. Identified hotspots suggest localized transmission, warranting targeted interventions. Enhanced surveillance and research efforts are crucial for understanding disease dynamics and implementing effective control measures. Priority should be given to vulnerable populations and high-burden regions to mitigate leishmaniasis impact in Pakistan.

PMID:39879501 | DOI:10.1590/1519-6984.284742

Am J Speech Lang Pathol. 2025 Jan 29:1-12. doi: 10.1044/2024_AJSLP-24-00284. Online ahead of print.

ABSTRACT

PURPOSE: Cerebral palsy (CP) is the most prevalent motor disability affecting children. Many children with CP have significant speech difficulties and require augmentative and alternative communication (AAC) to participate in communication. Despite demonstrable benefits, the use of AAC systems among children with CP remains constrained, although research in Canada is lacking.

METHOD: Data were collected as part of an exploratory survey of Canadian caregivers and clinicians (N = 60) who shared their perspectives on children’s need for, access to, and use of AAC systems. Quantitative data were summarized using descriptive statistics. Qualitative data were analyzed using inductive content analysis.

RESULTS: Caregivers and clinicians reported high rates of need for AAC systems (> 75%) among children with CP. Both groups reported that access was roughly equivalent to need, although caregiver reports were lower. Despite high rates of need and access, only 38% of children used AAC systems. Children who used AAC primarily used high-tech systems, mostly to make choices, rather than engaging in meaningful reciprocal interactions and conversations.

CONCLUSIONS: Canadian children with CP who required AAC systems generally received them. However, AAC systems were not used to their full potential, suggesting limited participation in social and learning situations. Like reports on other pediatric populations, barriers to obtaining AAC systems related to service, family, and child-specific factors. Although our sample captured the complexity present in the CP population, sample sizes were small and unlikely to be representative of the population of Canada, indicating the need for further research on a national scale.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.28229720.

PMID:39879487 | DOI:10.1044/2024_AJSLP-24-00284

JMIR Med Inform. 2025 Jan 29;13:e63109. doi: 10.2196/63109.

ABSTRACT

BACKGROUND: While expert optometrists tend to rely on a deep understanding of the disease and intuitive pattern recognition, those with less experience may depend more on extensive data, comparisons, and external guidance. Understanding these variations is important for developing artificial intelligence (AI) systems that can effectively support optometrists with varying degrees of experience and minimize decision inconsistencies.

OBJECTIVE: The main objective of this study is to identify and analyze the variations in diagnostic decision-making approaches between novice and expert optometrists. By understanding these variations, we aim to provide guidelines for the development of AI systems that can support optometrists with varying levels of expertise. These guidelines will assist in developing AI systems for glaucoma diagnosis, ultimately enhancing the diagnostic accuracy of optometrists and minimizing inconsistencies in their decisions.

METHODS: We conducted in-depth interviews with 14 optometrists using within-subject design, including both novices and experts, focusing on their approaches to glaucoma diagnosis. The responses were coded and analyzed using a mixed method approach incorporating both qualitative and quantitative analysis. Statistical tests such as Mann-Whitney U and chi-square tests were used to find significance in intergroup variations. These findings were further supported by themes extracted through qualitative analysis, which helped to identify decision-making patterns and understand variations in their approaches.

RESULTS: Both groups showed lower concordance rates with clinical diagnosis, with experts showing almost double (7/35, 20%) concordance rates with limited data in comparison to novices (7/69, 10%), highlighting the impact of experience and data availability on clinical judgment; this rate increased to nearly 40% for both groups (experts: 5/12, 42% and novices: 8/21, 42%) when they had access to complete historical data of the patient. We also found statistically significant intergroup differences between the first visits and subsequent visits with a P value of less than .05 on the Mann-Whitney U test in many assessments. Furthermore, approaches to the exam assessment and decision differed significantly: experts emphasized comprehensive risk assessments and progression analysis, demonstrating cognitive efficiency and intuitive decision-making, while novices relied more on structured, analytical methods and external references. Additionally, significant variations in patient follow-up times were observed, with a P value of <.001 on the chi-square test, showing a stronger influence of experience on follow-up time decisions.

CONCLUSIONS: The study highlights significant variations in the decision-making process of novice and expert optometrists in glaucoma diagnosis, with experience playing a key role in accuracy, approach, and management. These findings demonstrate the critical need for AI systems tailored to varying levels of expertise. They also provide insights for the future design of AI systems aimed at enhancing the diagnostic accuracy of optometrists and consistency across different expertise levels, ultimately improving patient outcomes in optometric practice.

PMID:39879089 | DOI:10.2196/63109

JAMA Cardiol. 2025 Jan 29. doi: 10.1001/jamacardio.2024.5281. Online ahead of print.

ABSTRACT

IMPORTANCE: A comprehensive lipid panel is recommended by guidelines to evaluate atherosclerotic cardiovascular disease risk, but uptake is low.

OBJECTIVE: To evaluate whether direct outreach including bulk orders with and without text messaging increases lipid screening rates.

DESIGN, SETTING, AND PARTICIPANTS: Pragmatic randomized clinical trial conducted from June 6, 2023, to September 6, 2023, at 2 primary care practices at an academic health system among patients aged 20 to 75 years with at least 1 primary care visit in the past 3 years who were overdue for lipid screening. Data analysis was performed from September 2023 to May 2024.

INTERVENTIONS: Eligible patients were randomized in a 1:2:2 ratio to usual care (group 1), direct outreach and bulk orders (group 2), and bulk order outreach with additional text message reminders for scheduling assistance (group 3). In group 3, participants received an initial, follow-up, and reminder text message. Patients with electronic portal accounts were encouraged to schedule through them, while others received laboratory contact information. Any participant inquiries were answered either with automated responses for common questions or with study team support.

MAIN OUTCOMES AND MEASURES: Proportion of patients who completed a lipid panel within 3 months.

RESULTS: Among the 1000 participants, the median (IQR) age was 38 (28-55) years; 470 (47.0%) were female; and 22 (2.3%) were Asian, 38 (3.9%) were Black, 32 (3.2%) were Hispanic or Latino, and 862 (88.6%) were White (race and ethnicity were based on self-reported data). At 3 months, a lipid panel was completed by 12 of 202 patients (5.9%; 95% CI, 3.4% to 10.1%) receiving usual care (group 1) vs 62 of 394 patients (15.7%; 95% CI, 12.5% to 19.7%) receiving direct outreach and bulk order (group 2), a difference of 9.8 percentage points (95% CI, 4.6 to 15.0; P = .001). The panel was completed by 73 of 404 patients (18.1%; 95% CI, 14.6% to 22.1%) receiving outreach, bulk order, and text message reminders (group 3), for a difference of 2.4 percentage points (95% CI, -3.1 to 7.8; P = .43) vs outreach with bulk order alone (group 2). At 6 months, there were no significant differences in lipid screening between either group 1 vs group 2 or group 2 vs group 3.

CONCLUSIONS AND RELEVANCE: Lipid screening among participants receiving bulk orders and outreach letters increased significantly compared with usual care at 3 months. However, there was no difference at 6 months. More than 80% of patients did not follow through with lipid screening despite the intervention, and there was no additional increase in lipid testing at 3 months among participants receiving bulk ordering and supplemental text messaging.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05724615.

PMID:39879069 | DOI:10.1001/jamacardio.2024.5281